Anorexia and Treatment

Anorexia Overview

Anorexia nervosa is an eating disorder that impacts mind, body and spirit. It is characterized by an intense fear of gaining weight and a distorted view of one’s own body. Because they view themselves as “fat” even when they are thin, people with anorexia starve in order to lose weight and may exercise excessively, sometimes to the point of becoming dangerously thin.

A person may be diagnosed with anorexia when their weight is at least 15 percent less than their normal body weight. Left untreated, anorexia can lead to life-threatening health complications, such as heart problems, kidney damage and osteoporosis.

Who Is at Risk for Anorexia?

Anorexia typically develops during adolescence and affects more women than men. However, in recent years, research suggests that eating disorders may develop even earlier in childhood and may continue to be a problem into adulthood. They are also affecting a growing number of boys and men.

In general, individuals with anorexia are intelligent and ambitious, typically excelling at work or in school. The disorder is more common among those in body-focused careers and activities, such as acting or modeling, as well as sports such as gymnastics, figure skating, wrestling, cheerleading and dancing.

 

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Causes

A popular misconception is that anorexia is caused by a fear of food. In most cases, anorexia has little to do with food. Instead, the eating disorder develops in an attempt to control some part of life, or to cope with difficult feelings or experiences.

Other factors that may play a role include:

  • Genetics/family history
  • Personality (being a perfectionist, a chronic worrier or extremely sensitive to criticism)
  • Social pressures to be thin
  • Low self-esteem
  • Other mental health issues (such as anxiety, depression or obsessive compulsive disorder)
  • Having a career or hobby that emphasizes weight or body size (such as dance, modeling or athletics)
  • Stressful life events (such as divorce, loss of a loved one, relocating or a new job)
  • Strained relationships with family or friends
  • Weight-related bullying or peer pressure
  • Hormonal changes

While the precise causes of anorexia are unknown, there are a number of risk factors that may increase the chances of developing anorexia, such as being:

  • Female
  • A teenager
  • Related to someone with anorexia or another eating disorder
  • On a diet
  • Stressed

Symptoms

People with anorexia lose weight in a variety of ways, such as starvation, excessive exercise, purging and laxative abuse. Anorexia is characterized by the following symptoms:

  • Rapid, unexplained weight loss (often hidden by wearing loose clothing)
  • Obsessing over food, calories, weight and body shape
  • Intense fear of gaining weight
  • Unusual eating habits such as eating in secret
  • Low self-esteem
  • Unrealistic or distorted self-perception (i.e., feeling fat even when underweight)
  • Perfectionism or being extremely critical of oneself
  • Compulsive exercise or use of laxatives, diuretics or diet pills to lose weight
  • Depression, anxiety or irritability
  • Dizziness or fainting
  • Irregular menstrual periods in females
  • Withdrawing from friends or loved ones
  • Difficulty tolerating cold weather, brittle hair and nails, dry skin, constipation and other physical symptoms

Anorexia is associated with serious, sometimes life-threatening health complications such as:

  • Irregular heartbeat
  • Low blood pressure
  • Dehydration
  • Osteoporosis
  • Swelling of arms or legs

Does Your Loved One Have Anorexia?

People with anorexia often take extreme measures to hide their eating disorder. For this reason, the symptoms of anorexia may go unnoticed and untreated for long periods of time, resulting in a need for longer, more intensive treatment later on.

If you believe someone you care about may have an eating disorder, look for the following anorexia warning signs and contact a physician, counselor or eating disorder treatment program for a more detailed assessment.

  • Constantly talking about food or complaining about weight
  • Frequent weigh-ins and/or self-checks in the mirror
  • Skipping meals
  • Making excuses for skipping meals
  • Eating a limited number of foods (typically low-fat, low-calorie foods)
  • Unusual eating habits such as cutting food into small pieces, moving food around the plate or not wanting to eat in public
  • Preparing meals for others but refusing to eat

Treatment for Anorexia

Anorexia can be difficult to treat. Denial and resistance to anorexia treatment are frequently part of the disease. As the voice of the eating disorder strengthens, people with anorexia may feel more concerned about their weight than their health and well-being. Some may visit pro-anorexia (“pro-ana”) websites, which promote anorexia as a positive lifestyle choice.

The three settings most appropriate for anorexia treatment include:

  • Hospitalization — This is the most intense level of care, and is appropriate when the individual’s life is in immediate danger from medical or psychiatric problems, such as suicidal thoughts or behaviors or severe malnutrition.
  • Residential Anorexia Treatment — A highly structured and supervised setting, where patients benefit from comprehensive treatment tailored to their particular needs.
  • Outpatient Anorexia Treatment — An ideal setting for those in recovery from anorexia who may need ongoing support and therapy. Outpatient anorexia treatment may also be appropriate for those who are in the early stages of the disease.

Because eating disorders are diseases of the mind, body and spirit, treatment must address all of these areas. Anorexia treatment may include:

  • Medical Care — A doctor or nurse may regularly measure vital signs and address hydration, electrolytes and re-feeding issues.
  • Weight Restoration — Restoring patients to a healthy weight is an essential part of anorexia treatment. This is done in a variety of ways, including meal planning sessions with a dietician, processing groups before, during and after mealtime, and grocery store and restaurant outings to learn about nutrition.
  • Individual Therapy — Patients meet with a therapist for individual therapy using a number of therapeutic approaches, including cognitive-behavioral therapy, dialectical behavior therapy and others. The goal of therapy is to teach healthy coping skills, increase self-esteem, and address any sensitive personal issues or co-occurring disorders such as depression or anxiety.
  • Group Therapy — Those suffering from anorexia get support and honest feedback from others with similar struggles. Group therapy can be helpful in overcoming denial, challenging distorted thinking and enhancing the patient’s self-esteem.
  • Culinary Therapy — In residential anorexia treatment programs, a chef may provide cooking lessons and assistance with preparing and eating meals.
  • Nutrition Therapy — Patients may meet with a dietician for nutrition education and meal planning, usually in a residential anorexia treatment setting. The dietician will help restore healthy eating patterns and teach the importance of a balanced diet.
  • Medication — Doctors may recommend certain medications to help manage the symptoms of anxiety and depression often associated with anorexia.
  • Family Therapy — Research shows that family therapy is critically important in treating eating disorders, particularly for adolescents. Families often play a significant role in helping the patient to feel supported in their recovery and to stick to aftercare plans. They are also educated about recognizing signs of eating disorder relapse.

During periods of transition or stress, individuals in recovery from an eating disorder may be vulnerable to anorexia relapse. For some, anorexia is an ongoing battle that requires continuous monitoring, therapy and education.

With treatment, people suffering from anorexia can develop more effective coping skills, establish healthy eating habits and reverse some of the health complications associated with anorexia. By breaking through the resistance, eating disorder specialists can help patients realize that they are worthy and valued regardless of their weight.